Physical Interventions, Risk, Training and Retraining

Organisations that train staff in physical intervention (restraint) techniques such as Team Teach, PRICE, CALM etc generally advise on training needs (including retraining needs) in relation to the level of risk in the school. Traditionally this has meant the special schools, which naturally have a higher level of challenging behaviour (CB) than mainstream schools, potentially classify as a higher level of risk. In turn this has attracted advice to the effect that all staff need an initial two days training with a further one day at regular (either annual or bi-annual) intervals.
 
I believe however, that schools who are on top of CB operate on certain key principles which, when executed well, significantly reduces the risk of physical intervention. That is, such schools (i) have a proactive rather than a reactive policy to CB (ii) regard any physical intervention as a ‘failure’ and therefore a cause for concern (iii) do not use static holds such as holding to chairs or wrapping holds for smaller children, and will NEVER take any children or young people to the floor. Let’s look at these in turn.
 
(i) Operating a proactive rather than a reactive policy implies that the school will seek to resolve serious and habitual behaviours before they happen rather than afterwards. This involves not waiting for the behaviour to occur but listening to the behaviours, and crucially ACTING on such communications, because these behaviours are telling us something, usually involving ‘I don’t want to do this or to be here’ and/or ‘I need attention’. This is I accept, a fairly simplistic interpretation, and if you want more depth I have put a reading list at the bottom of this post. The principle is however, sound. If we merely follow the physical intervention training, whoever it is from, we are in real danger of waiting for the behaviour to happen in order to distract or defuse or guide away or hold, because naturally, that’s what the training is about.
 
(ii) Regarding any physical intervention as a ‘failure’ naturally springs from the proactive policy. If schools are regularly holding and/or restraining, and particularly if they are regularly holding and/or restraining specific (named) children/young people, their proactive policy is clearly not working. Holding and/or restraining is not good for anyone, the child, the staff, the parents, society at large. Two recent BBC programmes (one on the radio, one on TV) highlighted the potentially catastrophic and illegal consequences of regular restraint. Of course things will occasionally go wrong, and schools therefore need training in guiding children to a safe place, but even this must not become the norm, and if it is, this must be a serious cause for concern. 

(iii) Not using static holds, forces schools to think inventively about enabling learners to take control of their own behaviour. That is, static holds are about overpowering, forcing children to be still, and give the message that if you can’t control your own behaviour, I will control it for you. This is however, an extraordinarily negative message. We should be teaching learners to take responsibility for their own behaviour, and they’ll never be able to do that when they’re pinned to a chair or to the floor. Using guiding holds such as a two person single elbow, or a single person double elbow or (as the least intrusive) a caring C guide above the elbow (these are all Team Teach names, but I believe that other organisations use similar holds) enables staff to guide the learner to a safe space where they can come down in their own time. I fully accept that such a policy needs careful planning and thought and of course space, but if the proactive policy – listening to the behaviours and acting on the learners’ communications – are done well, there will be no need for static holds and a considerably reduced need for guiding holds.
 
The point about this is that the rejection of static holds significantly reduces the need for two day initial training and one day follow up training and schools do perhaps need to be much more insistent about devising a policy that suits them. I would suggest that the initial training should revolve around simple ‘escapes’, safe spaces, and the guiding holds noted above, which would take one day at the most. I personally would be much more concerned with ensuring that all staff have understood and agreed on a proactive policy, because that will ensure that reactive strategies, such as escapes and guiding holds are kept to an absolute minimum. I am certainly not accusing physical handling training organisations of operating a cash cow, but there is not a legal minimum standards training requirement, and these organisations have a moral responsibility to try and keep schools’ costs to a minimum by advising them on ‘appropriate’ levels of training. BILD (the British Institute of Learning Disabilities) currently accredits some 40 physical intervention training organisations, but there is no legal sanction to this and it is not an Ofsted or DfE requirement that organisations who train schools are on this list. It should be noted for example that Team Teach, one of the biggest organisations currently working in special schools, are no longer on BILD’s list.
 
Finally, and crucially, the rejection of static holds also leads to a realignment of risk. If schools are only using guiding holds to enable learners to get to a safe space as quickly as possible, the ‘risk’ factor, that is, the risk of using invasive and potentially dangerous restrictive holds, becomes significantly reduced. Special schools who regard challenging behaviour as normal (Hewett, 1998) are usually much less likely to make a crisis out of an everyday event, and are actually, probably significantly better at the whole issue of working with CB than the traditionally low risk mainstream school. This low risk assessment also has a knock on effect on retraining, so that schools might think of an additional hour or so after school just to ensure that that standard guiding holds noted above are understood and remembered. This training can of course, be done by the school’s own trainers.
 
In conclusion therefore, I would suggest that special schools invest much more time in ensuring a proactive behaviour philosophy, and much less time on learning holds and strategies they probably shouldn’t be using in the first place. This would make for a considerably reduced training and re-training obligation, save time and money, and lead schools towards a safer, more positive practice which is better for learners, staff, parents/carers and society in general.

Peter Imray
peter.imray@hotmail.co.uk

 
Reference

Hewett D (1998b). Challenging Behaviour is Normal in P Lacey and C Ouvry (eds) People with Profound and Multiple Learning Difficulties. London. David Fulton.
 
Reading List
 
Amid the plethora of books on challenging behaviour there are (still!) very few books relating to CB and PMLD/SLD. In which case the old ones are probably the best if you can get hold of them, namely
 
Harris J, Cook M and Upton G (1996). Pupils with Severe Learning Disabilities who present Challenging Behaviour. Kidderminster. BILD.
 
Harris J, Hewett D and Hogg J (2001). Positive Approaches to Challenging Behaviour. Kidderminster. BILD.
 
For more up to date thoughts I would advise looking at
 
Imray P (2017) (2nd ed) Turning the Tables on Challenging Behaviour. London. Routledge.
 
Imray P and Hewett D (2015) Challenging Behaviour and the curriculum in P Lacey, R Ashdown, P Jones, H Lawson and M Pipe (eds) The Routledge Companion to Severe, Profound and Multiple Learning Difficulties. London. Routledge.
 
And finally, still the best book on ASD and SLD
Jordan R (2001). Autism with Severe Learning Difficulties. London. Souvenir Press.
 


 

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